Okay, some people are smoking some bad dope.
Whilst helping the PharmKid get down to the car for school this morning, I came upon PharmGirl, MD, in a rage while sitting in front of her laptop. The object of her vitriol was a 17 April article in BusinessWeek entitled, “Are There Too Many Women Doctors?: As an MD shortage looms, female physicians and their flexible hours are taking some of the blame.” The article derives from a point/counterpoint pair of essays in the 5 April issue of BMJ (British Medical Journal) entitled, “Are there too many female medical graduates?” (“Yes” position, “No” position – free full text at the time of this posting)
While the BMJ essays primarily address issues in the UK, they are common to the US and many other countries – BusinessWeek’s Catherine Arnst describes the long-term problem that underlies concerns about too many women in medicine:
Various studies have projected a shortfall of anywhere from 50,000 to 100,000 physicians in the U.S. relative to demand by 2020, and the Institute of Medicine, a federal advisory body, just reported that in a mere three years senior citizens will be facing a health-care workforce that is “too small and woefully unprepared.”
One cannot deny these facts. But an argument has been made that the increased representation of women among medical graduates is increasing the number of physicians who work part-time or drop out of the physician pool altogether when having children.
“It’s pretty much an even bet that within a year or two of entering practice they will go on maternity leave,” says Phillip Miller, a vice-president of the medical recruiting firm Merritt, Hawkins & Associates. “Then they are going to want more flexible hours.”
Such demands tend to irritate older doctors. “The young women in our practice are always looking to get out of being on-call,” says a male internist at a large New York-area medical group who asked not to be named. “The rest of us have to pick up the slack. That really stirs up a lot of resentment.”
Arnst herself counters these anecdotal assertions with one of many advantages of increased numbers of women physicians:
On the plus side, women are willing to take on lower-paying specialties that male doctors are moving away from, such as primary care, pediatrics, and obstetrics. Since 1996 there has been a 40% jump in the number of women choosing primary care, offsetting the 16% decline in men entering the field.
Moreover, Arnst points out that the issue may be more one of all docs choosing to seize back more of their lives, rather than an issue of gender:
The issue of shorter work weeks may in fact be as much generational as gender-based. Newly minted male doctors are also rejecting the heroic 80-hour weeks put in by physicians of yesteryear.
I’m not a physician but I would submit that I have made changes in my own career to support the mission of my physician wife, an issue kindly brought to light by Canadian ER doc, Couz, on her excellent blog, Tales from the Emergency Room and Beyond:
In all seriousness, I wouldn’t have married me. My husband is a glutton for punishment.
Again, this may be anecdote, but an anonymous commenter on the long thread following the BusinessWeek article confirms my experience with most of PharmGirl’s female colleagues: they bust their asses to do their jobs despite biology and societal pressure to be doctors first and women second:
It is interesting that the statistics did not talk about female physicians who work full time similar to their male counterparts. I am a full time female physician who works long hours just like my male colleagues. I took only eight weeks for maternity leave twice during my career. I never entertained working part-time for economic and financial issues. But I always had to live with the guilt of not having enough time with my family and spending too much money for hiring nannies. Perhaps Dr. Nancy Oriol’s comments has to be taken wholeheartedly that there might be some issues with retention. We should consider alternative ways of making the discipline accommodating for the younger generation who have to juggle work and life balance.
Indeed. The closing point from the Harvard dean of students punctuates this discussion:
Ultimately, medicine will have to accommodate the lifestyle demands of a younger generation if it is to address the physician shortage, says Dr. Nancy Oriol, dean of students for Harvard Medical School. “If there is a problem with retention, it might serve us well to investigate details of the career paths themselves.”
Finally, I’m of the mind of commenter MDeducator who notes that we men, physicians or otherwise, need to sack up and support what is good about women in medicine:
It is pathetic and ludicrous to blame the physician shortage on female physicians. If it weren’t for them, flexibility would not exist in this career, and patients would be able to connect with us even less than they do now. The primary care shortage would also be far more pronounced than it is now. Until we adopt more human behaviors, such as the ones women have brought to our career, we will always have difficulty with malpractice lawsuits. Perhaps taking on some child care responsibilities as male physicians might do us some good. We may even be able to relate better to humanity??? as well as our patients.
I recognize that I’ve rambled on a bit here based mostly on the emotional and anecdotal aspects of this question. I’m still working my way through the references cited in the two BMJ essays but I see generally that there are conflicting data on whether women contribute more or less to the physician pool (i.e., they may take off nine months here and there but they have greater life expectancy and may work longer). Moreover, the glass ceiling for women in medicine may also mean that they stay in the working physician pool longer because the administrative ranks are often closed to them, as cited in the BMJ essay by Dr Jane Dacre, vice dean of University College London:
The Medical Schools Council report, published in June 2007 showed only 11% of the professorial staff in UK medical schools are women compared with 36% of clinical lecturers. The proportion of women decreases with increasing academic grade. A similar situation exists in the United States, where only 15% of full professors and 11% of department chairs are women.
In this context, regular readers may recall my take on a NEJM article by Nancy Andrews, MD, PhD, appointed in 2007 as the first female dean of a top 10 US college of medicine, where she is incredulous at the national and local response to her taking the helm:
…it continues to be true that we do not expect women to hold certain positions in society or medicine. Recently, I witnessed firsthand the persistence of such expectations, when my husband, our children, and I went to visit a school in North Carolina where Duke staff members had made an appointment for the family of the new dean of the medical school. As we entered the school, its principal vigorously shook my husband’s hand and welcomed him, saying, “You must be the man of the moment.” Unfortunately, it is quite understandable that it wouldn’t have crossed his mind that I might be the “woman of the moment” instead…
The bottom line is that several major medical societies agree that a physician shortage looms as baby boomers transition into being patients for the most medically-intensive stage of life. But to blame women physicians, even partly, for this problem is absolutely absurd. Women bring unique and necessary gifts to the practice of medicine and pursue specialty areas that men would rather not. Let’s give them appropriate credit and work on the real problems of society and the medical patriarchy in solving what might be a real issue of the retention of female physicians.
Note added in proof: I was reminded by his comment below that PalMD had a very thoughtful post on this topic on 13 April.